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Looking for the best treatment for knee arthritis pain? Here’s what an orthopedic surgeon wants you to know

By Dr. Pier Boutin, MD

Knee pain from arthritis is so common now it can almost seem inevitable.  There are many reasons for that — but at some point, you’re past preventing the damage.  The question becomes: what are my options for treating knee pain caused by arthritis?

 A woman with knee arthritis

(If you are in the early stages of arthritis of your knees, I encourage you to hop over to my other blog “Arthritis is your warning sign to not stop moving” for lifestyle changes that can help ease the inflammation at the root of arthritis pain.  You’ve got a lot of good options!)

The changes I recommend early-stage sufferers can help mitigate pain in advanced cases too.  Exercise and an alkaline diet can lower inflammation as well as conventional medication — often even better! 

But  if you have moderate to severe knee arthritis, or have had arthritis for an extended time, relieving pain and restoring mobility takes extra effort. As arthritis in the knee progresses, cartilage and menisci that usually provide padding to the knee joint begin to soften, thin and eventually disappear, leaving bone exposed to bone. This destructive spiral limits function — and increases pain. 

At this point, your only options are knee replacement or injections for the pain.  Since knee replacement doesn’t last forever, and comes with a risk of complications, your doctor will often recommend an injection for the pain. 

Now you’re faced with another set of choices.  Options for injections include cortisone, hyaluronic acid (HA) or platelet-rich plasma (PRP). It’s important to understand what to expect from each type of injection — including the treatment’s ability to address the underlying problem. 

Cortisone for arthritic knee pain — “magic” that doesn’t last 

Cortisone is a potent anti-inflammatory medication. Acutely swollen and painful knees usually respond within a few days to a cortisone injection. For many, the relief is so sudden and total that it feels magical. However, the power of the injection subsides after 4-6 weeks and unfortunately, the pain usually comes right back. Cortisone needs to be used judiciously —  no more than three or four injections per year — because repeated use may actually lead to further cartilage deterioration, worsening the arthritis — and the pain.

If a total knee replacement is indicated, cortisone must be avoided for at least six months prior to surgery as studies show a slight increase in post-op infection after injections. Long story short: cortisone injections are effective for relieving symptoms of acute knee pain, but I’m sorry to say that cortisone cannot alleviate long term pain — and may cause even more problems.

Hyaluronic acid (HA) — a lubricating molecule for longer lasting relief

For some patients with knee pain, hyaluronic acid (HA) injections are often a better option than cortisone. HA is often referred to as a “gel” or “lubricant” for the knee. This molecule is naturally produced by the cartilage cells and gives cushioning and structure to the padding in the knee. In vitro, this molecule reduces inflammation. 

Common names of HA-based medications are Synvisc, Gelsyn, Durolane, Euflexxa and Hyalgan. Because the HA molecule is found naturally in the body, injections are generally safe and have few negative effects. Pain relief may take up to three weeks and last for six months. HA may be given as a one time dose or divided into a series of 3-5 doses. 

Hyaluronic acid injections offer longer-lasting pain relief. However, there’s evidence that some do not respond at all to HA, so you’ll need have limited expectations until you know how your body responds. Like cortisone, these injections are for pain relief: they do not reverse arthritis.

Platelet-rich plasma injections — activating the body’s natural healing abilities 

The cutting-edge option is platelet-rich plasma (PRP) treatments.  PRP injections are unique because they use a concentrate of platelets and growth factors obtained from your own blood. (You give a sample which is put into a centrifuge to concentrate the active agents.) These growth factor proteins stimulate cell growth and tissue repair, activating your body’s own natural healing abilities. 

The recommended dosing is three weekly injections . Relief from PRP injections is gradual and increases over several months. These injections not only relieve pain but appear to slow the progression of arthritis. There are few negative side effects because the concentrate is obtained from your own blood. 

To maintain joint protection, the series of injections should be repeated every year. This is a good option for patients who wish to delay or avoid knee replacement. A downside is that many insurance plans do not cover PRP injections for joints, though hopefully this will soon change. 

PRP + HA — the winning combination?

The current research indicates that a combination of platelet-rich plasma (PRP) treatment combined with hyaluronic acid (HA) injections may be the best option for long term pain relief and joint protection. 

New studies show significantly greater and longer-lasting pain relief when using this combination approach. Notably, the largest amount of connective tissue growth occurs when PRP is combined with HA. I have seen firsthand just how powerful this combination is for joint preservation and pain relief in my patients with arthritis. It can really work wonders for knee arthritis recovery! 

If you are someone who struggles with knee pain, talk to your doctor about these treatments — and do your best to shift your lifestyle. Taking steps through diet and exercise to reduce inflammation can still go a long way in providing relief even when knee aches and pain has gone on for years. Your knees may not be getting younger, but diet and exercise can flatten the curve of decline.  When treatment is needed, consider the pros and cons and what will best serve your knees now and in the future. 

What’s causing your joint pain? Find out if you should be worried about your symptoms.


Last Updated: June 9, 2021
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